Acute and long-term results of treatment of diffuse in-stent restenosis in aortocoronary saphenous vein grafts

Intracoronary stent implantation is used widely for treatment of atherosclerotic disease in native coronary arteries and saphenous vein graft (SVG) lesions because it reduces restenosis compared with percutaneous transluminal coronary angioplasty (PTCA).(1-3) As a result, in-stent restenosis (ISR), which is due to neointimal hyperplasia,(4) is becoming an increasingly important clinical problem. Although ISR can be treated with PTCA,(5,6) the reported clinical recurrence rate, especially in diffuse ISR, has been up to 80%.(7) Thus, alternative therapeutic approaches have been investigated. In a native coronary ISR study, we showed better long-term clinical outcome with excimer laser coronary angioplasty (ELCA) plus adjunct PTCA versus PTCA alone.(8) The long-term outcome after rotational atherectomy has also been reported to be superior to historical controls of PTCA treatment of native coronary ISR.(9) In the present study, we report on the clinical results of ELCA followed by adjunct PTCA for the treatment of diffuse ISR in SVGs.